External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT RESPONSE GUIDE

Mission: To safely manage the influx of patients due to the detonation of an IED.

Directions □ Read this entire response guide and review incident management team chart □ Use this response guide as a checklist to ensure all tasks are addressed and completed

Objectives □ Prepare for the influx/surge of trauma and burn victims □ Ensure facility security □ Patient triage and medical management □ Collect forensic evidence for law enforcement □ Communicate situation status and information to staff, patients, media and the public

Immediate (Operational Period 0-2 Hours) COMMAND

(Incident Commander):

 Activate the Command Staff and Section Chiefs

 Receive notification about the incident from local officials

 Notify the emergency department of possible incoming trauma, blast and burn casualties

 Activate the Emergency Operations Plan and the HCC □  Establish operational periods

 Establish operational objectives

(PIO):

 Monitor media outlets for updates on the incident and possible impacts on the hospital

 Establish a patient information center; coordinate with the Liaison Officer

 Establish a media staging/briefing area initiate media/communications plan External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT RESPONSE GUIDE

COMMAND

(Liaison):

 Establish communication with the field providers and the local EOC to ascertain incident information

 Communicate with other healthcare facilities to determine:

 Situation status

 Surge capacity including trauma and burn beds

□  Patient transfer/bed availability

 Capability to loan needed equipment, supplies, medications, personnel, etc.

(Safety Officer):

 Monitor safety practices related to staff, patients, and facility, and implement corrective actions to address or correct the problems

(Medical/Technical Specialist-Pediatric Care):

 Assist Operations Section Chief in identifying specific medical care management needs of children injured by the incident.

OPERATIONS

 Activate Medical Care, Infrastructure, HazMat, and Security Branch Directors

 Notify the emergency department of possible incoming trauma and burn casualties

 Consider the possibility of contaminated victims. Check for radiation and biological contamination of incoming casualties. If necessary, activate appropriate Medical/Technical Specialist

 Conduct hospital and clinic census to determine early discharges

 Provide facility security, traffic and crowd control □  Activate surge capacity plan and patient registration emergency procedures

 Prepare for fatalities in conjunction with local law enforcement, coroner/medical examiner and local EOC

 Rapidly triage and prioritize patient care and resources

 Arrange for transfer of critical trauma and burn patients to specialty care facilities, as appropriate

 Implement evidence collection procedures

 Liaison with law enforcement official to interview patients and gather evidence External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT RESPONSE GUIDE

PLANNING □  Prepare and implement patient, bed, materiel and personnel tracking  Establish operational periods and develop Incident Action Plan, in collaboration with the Incident Commander

LOGISTICS:

 Initiate staff call-back procedures to obtain additional staffing for impacted areas

□  Conduct an inventory of critical supplies, equipment, medications and blood products and obtain additional supplies as needed

 Ensure functionality of communications and IT/IS systems

Intermediate (Operational Period 2-12 Hours) COMMAND

(Incident Commander):

 Review incident objectives and Incident Action Plan, modify as needed

(PIO):

 Establish a patient information center, in collaboration with Liaison Officer

 Manage media relations, public information, risk communication and integrate public relations activities with the Joint Information Center

□ (Liaison Officer):

 Continue regular communication with the local EOC and other officials to ascertain situation status and communicate hospital status and needs

(Safety Officer):

 Continue to monitor safety practices of staff and patient safety and use of personal protective

(Medical/Technical Specialist-Pediatric Care):

 Assist Operations Section Chief in meeting specific medical care management needs of children injured by the incident. External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT RESPONSE GUIDE

OPERATIONS

 Implement procedures for patient valuables management, evidence collection and security

 Continue patient care and management activities

 Implement family notification procedures in conjunction with family assistance center operations

□  Ensure rapid patient registration

 Ensure proper waste water and expendable materials disposal

 Continue facility security, traffic and crowd control

 Continue to liaison with law enforcement agencies

 Implement forensic/evidence collection policies and procedures

PLANNING

 Continue patient, bed, materiel and personnel tracking □  Update and revise the Incident Action Plan

 Ensure documentation of patient care and hospital response

LOGISTICS

 Provide mental health support services for staff

 Facilitate procurement of supplies, equipment and medications for response and patient □ care

 Continue to provide supplemental staffing to impacted areas to maintain operations

 Ensure communications systems and IT/IS functionality

FINANCE/ADMINISTRATION □  Continue tracking response costs and claims and report to the Incident Commander External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT RESPONSE GUIDE

Extended (Operational Period Beyond 12 Hours) COMMAND

(Incident Commander):

 Continue regular briefing of Command staff/Section Chiefs. Address issues identified

(Public Information Officer):

 Continue patient information center, as necessary

 Coordinate efforts with local/state public health resources/JIC

(Liaison Officer):

□  Continue to ensure integrated response with local EOC

 Continue to communicate personnel/equipment/supply needs to local EOC

 Continue to update local public health of any health problems/trends identified

(Safety Officer):

 Continue to monitor safety practices and take appropriate corrective actions

(Medical/Technical Specialist-Pediatric Care):

 Continue to assist Operations Section Chief in meeting specific medical care management needs of children injured by the incident

OPERATIONS

 Continue patient care and management activities

 Facilitate law enforcement requests for patient/staff interviewing □  Maintain infrastructure support and services

 Continue security measures

 Plan for demobilization and system recovery

PLANNING

 Review and update the Incident Action Plan and plan for demobilization and system recovery □  Ensure documentation is being completed by all Sections

 Continue patient, personnel, materiel and bed tracking External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT RESPONSE GUIDE

LOGISTICS □  Provide for staff food and water  Ensure adequate supplies, equipment, personnel and facilities to support extended response operations

FINANCE/ADMINISTRATION

□  Compile response costs and submit to the Incident Commander

 Track any claims/injuries and complete appropriate documentation, compile report

Termination/System Recovery COMMAND

(Incident Commander):

 Oversee and direct demobilization and system recovery operations

(Public Information Officer): □  Provide final briefings as needed to patients/visitors/staff/media, in cooperation with JIC (Liaison Officer):

 Prepare a summary of the status of the hospital and disseminate to Command staff/Section Chiefs and to public health/EMS as appropriate

(Safety Officer):

 Oversee safe restoration to normal operations

OPERATIONS

□  Return patient care and services to normal operations

 Ensure evidence and appropriate documentation are provided to law enforcement officials External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT RESPONSE GUIDE

PLANNING

 Finalize the Incident Action Plan and demobilization plan

 Compile a final report of the incident and hospital response and recovery operations

 Ensure appropriate archiving of incident documentation

 Write after-action report and corrective action plan to include the following: □  Summary of actions taken  Summary of the incident

 Actions that went well

 Area for improvement

 Recommendations for future response actions

 Recommendations for correction actions

LOGISTICS

 Provide for mental health (acute and long term) services for staff and patients, in □ collaboration with Operations Section

 Restock supplies, equipment, medications and blood products to normal levels

FINANCE/ ADMINISTRATION

□  Submit final response expenses to the Incident Commander for approval and to appropriate external authorities for reimbursement or other assistance

Documents and Tools □ Hospital Emergency Operations Plan □ Hospital Decontamination Protocol □ Evidence Collection Policy □ Surge Capacity Plan/Mass Casualty Plan External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT MANAGEMENT TEAM CHART -- IMMEDIATE

Incident Commander

Public Safety Information Officer Officer

Biological /Infectious Disease Chemical Radiological Medical/ Clinic Administration Liaison Hospital Administration Technical Legal Affairs Officer Risk Management Specialist Medical Staff Pediatric Care Medical Ethicist

Finance/ Operations Planning Logistics Administration Section Chief Section Chief Section Chief Section Chief

Personnel Staging Vehicle Equipment /Supply Communications Unit Resources Personnel Tracking Service Time Manager Medication Service IT/IS Unit Time Materiel Tracking Unit Leader Branch Director Staff Food & Water Unit Unit Leader

Employee Health & Well-Being Unit Inpatient Unit Family Care Unit Outpatient Unit Support Support Supply Unit Medical Care Casualty Care Unit Situation Patient Tracking Procurement Facilities Unit Mental Health Unit Bed Tracking Branch Transportation Unit Branch Director Clinical Support Services Unit Unit Leader Unit Leader Labor Pool& Credentialing Unit Patient Registration Unit Director

Power/Lighting Unit Water/Sewer Unit HVAC Unit Compensation// Infrastructure Building /Grounds Damage Unit Documentation Medical Gases Unit Claims Branch Director Medical Devices Unit Unit Leader Environmental Services Unit Unit Leader Food Services Unit

Detection and Monitoring Unit HazMat Spill Response Unit Demobilization Cost Victim Decontamination Unit Branch Director Facility/Equipment Unit Leader Unit Leader Decontamination Unit

Access Control Unit Security Crowd Control Unit Traffic Control Unit Branch Director Search Unit Law Enforcement Interface Unit

Business Information Technology Unit Service Continuity Unit Legend Continuity Records Preservation Unit Business Function Relocation Unit Branch Director Activated Position External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT MANAGEMENT TEAM CHART -- INTERMEDIATE

Incident Commander

Public Safety Information Officer Officer

Biological /Infectious Disease Chemical Radiological Medical/ Clinic Administration Liaison Hospital Administration Technical Legal Affairs Officer Risk Management Specialist Medical Staff Pediatric Care Medical Ethicist

Finance/ Operations Planning Logistics Administration Section Chief Section Chief Section Chief Section Chief

Personnel Staging Vehicle Equipment/Supply Communications Unit Resources Personnel Tracking Service Time Manager Medication Service IT/IS Unit Time Materiel Tracking Unit Leader Branch Director Staff Food & Water Unit Unit Leader

Employee Health & Well-Being Unit Inpatient Unit Family Care Unit Outpatient Unit Support Support Supply Unit Medical Care Casualty Care Unit Situation Patient Tracking Procurement Facilities Unit Mental Health Unit Bed Tracking Branch Transportation Unit Branch Director Clinical Support Services Unit Unit Leader Unit Leader Labor Pool& Credentialing Unit Patient Registration Unit Director

Power/Lighting Unit Water/Sewer Unit HVAC Unit Compensation// Infrastructure Building /Grounds Damage Unit Documentation Medical Gases Unit Claims Branch Director Medical Devices Unit Unit Leader Environmental Services Unit Unit Leader Food Services Unit

Detection and Monitoring Unit HazMat Spill Response Unit Demobilization Cost Victim Decontamination Unit Branch Director Facility/Equipment Unit Leader Unit Leader Decontamination Unit

Access Control Unit Security Crowd Control Unit Traffic Control Unit Branch Director Search Unit Law Enforcement Interface Unit

Business Information Technology Unit Service Continuity Unit Legend Continuity Records Preservation Unit Business Function Relocation Unit Branch Director Activated Position External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT MANAGEMENT TEAM CHART -- EXTENDED

Incident Commander

Public Safety Information Officer Officer

Biological /Infectious Disease Chemical Radiological Medical/ Clinic Administration Liaison Hospital Administration Technical Legal Affairs Officer Risk Management Specialist Medical Staff Pediatric Care Medical Ethicist

Finance/ Operations Planning Logistics Administration Section Chief Section Chief Section Chief Section Chief

Personnel Staging Vehicle Equipment/Supply Communications Unit Resources Personnel Tracking Service Time Manager Medication Service IT/IS Unit Time Materiel Tracking Unit Leader Branch Director Staff Food & Water Unit Unit Leader

Employee Health & Well-Being Unit Inpatient Unit Family Care Unit Outpatient Unit Support Support Supply Unit Medical Care Casualty Care Unit Situation Patient Tracking Procurement Facilities Unit Mental Health Unit Bed Tracking Branch Transportation Unit Branch Director Clinical Support Services Unit Unit Leader Unit Leader Labor Pool& Credentialing Unit Patient Registration Unit Director

Power/Lighting Unit Water/Sewer Unit HVAC Unit Compensation// Infrastructure Building /Grounds Damage Unit Documentation Medical Gases Unit Claims Branch Director Medical Devices Unit Unit Leader Environmental Services Unit Unit Leader Food Services Unit

Detection and Monitoring Unit HazMat Spill Response Unit Demobilization Cost Victim Decontamination Unit Branch Director Facility/Equipment Unit Leader Unit Leader Decontamination Unit

Access Control Unit Security Crowd Control Unit Traffic Control Unit Branch Director Search Unit Law Enforcement Interface Unit

Business Information Technology Unit Service Continuity Unit Legend Continuity Records Preservation Unit Business Function Relocation Unit Branch Director Activated Position External Scenario 12 EXPLOSIVES ATTACK – IMPROVISED EXPLOSIVE DEVICE

INCIDENT MANAGEMENT TEAM CHART -- DEMOBILIZATION

Incident Commander

Public Safety Information Officer Officer

Biological /Infectious Disease Chemical Radiological Medical/ Clinic Administration Liaison Hospital Administration Technical Legal Affairs Officer Risk Management Specialist Medical Staff Pediatric Care Medical Ethicist

Finance/ Operations Planning Logistics Administration Section Chief Section Chief Section Chief Section Chief

Personnel Staging Vehicle Equipment /Supply Communications Unit Resources Personnel Tracking Service Time Manager Medication Service IT/IS Unit Time Materiel Tracking Unit Leader Branch Director Staff Food & Water Unit Unit Leader

Employee Health & Well-Being Unit Inpatient Unit Family Care Unit Outpatient Unit Support Support Supply Unit Medical Care Casualty Care Unit Situation Patient Tracking Procurement Facilities Unit Mental Health Unit Bed Tracking Branch Transportation Unit Branch Director Clinical Support Services Unit Unit Leader Unit Leader Labor Pool& Credentialing Unit Patient Registration Unit Director

Power/Lighting Unit Water/Sewer Unit HVAC Unit Compensation// Infrastructure Building /Grounds Damage Unit Documentation Medical Gases Unit Claims Branch Director Medical Devices Unit Unit Leader Environmental Services Unit Unit Leader Food Services Unit

Detection and Monitoring Unit HazMat Spill Response Unit Demobilization Cost Victim Decontamination Unit Branch Director Facility/Equipment Unit Leader Unit Leader Decontamination Unit

Access Control Unit Security Crowd Control Unit Traffic Control Unit Branch Director Search Unit Law Enforcement Interface Unit

Business Information Technology Unit Service Continuity Unit Legend Continuity Records Preservation Unit Business Function Relocation Unit Branch Director Activated Position